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UNDERGROUt _TANK PROGRAM OFFICIAL INSP'TION REPORT �--- SAN JOAQUIN HEALTH DISTRICTS 1601 E. HAZELTON AVE. COUNTY NAME SQ.y� �� PHONETONNO. 468-9342203 = COUNTY # 39 SITE NAME: �CR41--1 k". _,o INSPECTION DATE: SITE ADDRESS: CITY/STATE/ZIP S fly Cdr �,>NQS CHANGES SITE/OWNER/PERMIT? YES NO TANK a TANK TANK TANK FORM A AND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER TYPE OF INSPECTION SITE COMPUTER# NUMBER NUMBER NUMBER NUMBER ptuj h �{y PER# PER# PER# PER# d EXP DATE EXP DATE EXP DATE _ EXP DATE OPERATIONAL TANK TANK CONTENTS g � z MAJOR MINOR PERMIT TO OPERATE 1 2 . , CHANGE IN CONDITIONS TO OPERATE 3 4 APPROVED CONSTRUCTION 5 6 — - ---•• r WRITTEN MONITORING PROCEDURES 7 8 APPROVED MONITORING SYSTEM 9 10 i MONITORING SYSTEM 11 12 + APPROVED MONITOR FREQUENCY 13 114 MONITORING RECORDS MAINTAINED 15 16 ACCESS CASING SECURED 17 i8 PIPING 19 20 + INVENTORY RECONCILIATION 21 22 TANK GAUGING 23 24 —- APPROVED RESPONSE PLAN 25 26 r J UNAUTHORIZED RELEASE OCCURRENCE 27 28 SAMPLING 29 30 APPROVED TANK REPAIRS 31 32 UNAUTHORIZED RELEASES REPORTED 33 134 1 ` SAFETY HAZARD 35 36 CONDITIONS ABATED 37 -- TEMPORARY TANK CLOSURE REMOVAL OF RESIDUAL 38 39 FLAMMABLE VAPORS REMOVED ACCESS LOCATIONS SEALED 41 42 POWER DISCONNECTED 43 -- OWNER/OPERATOR MONITORING 44 45 PERMANENT TANK CLOSURE "aL. ...._ REMOVAL OF RESIDUAL MATERIALS 46 47 PIPING 48 49 - FLAMMABLE VAPORS REMOVED 50 UNAUTHORIZED RELEASE 51 52 � ---- SAMPLING 53 54 IMPROPER ABANDONMENT 55 56 THE MARKED ITEMS REPRESENT VIOLATIONS AND MOST BE CORRECTED AS SYSTEM STATUS(MUST MARK ONE) FOLLOWS: MAJOR 57 MINOR 58NO 59 VIOL. ❑ VIOL. VIOL❑ S t OFFICE: INSP: RECEIVED BY: 3 f TITLE: V I ��s PHONE: BECK: HUT-3 ORIGINAL 5/ea ©M